advanced airway management 1
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EMT BasicAdvanced Airway
ManagementPharyngeal Esophageal Airway Device
(PEAD)
A.K.A. Combitube©
PowerPoint developed by Jennifer Stanislaw, EMT-P, EMS Training Officer West Valley Fire District, Willamina, OR
The Cat Fan (No Pun Intended)
Agenda Review Objectives Lesson 1
Respiratory Anatomy & Physiology
Lesson 2 Respiratory Volume and Management
Lesson 3 Assessing Respiratory Problems
Agenda cont’d Lesson 4
Respiratory/Cardiac Arrest Basic Airway Management
Lesson 5 Suctioning
Lesson 6 Dual-Lumen Airway Devices
Agenda cont’d Demonstration Practical Stations
Basic Airway Management Manual Maneuvers and Simple Adjuncts Supplemental Oxygen Ventilation Suctioning
Combitube Insertion
Practical Testing must be done with the Physician
Advisor (or another Physician of his / her choosing)
Objectives Describe the anatomy and function of the upper
and lower airways Describe respiratory volumes and capacities in
relationship to the need for assisted ventilations Identify the specific observations and physical
findings commonly found in patients presenting in respiratory and/or cardiac arrest.
Identify the basic principles of airway management
Objectives (cont’d) Describe the indications for suctioning. Identify rigid and flexible suction catheters
and the indications for use. Identify indications and contraindications for
use of the PEAD’s. Identify the advantages and disadvantages
of using PEAD’s.
Objectives (cont’d) Identify those situations in which PEAD’s
may be removed. Demonstrated placement of PEAD’s. Demonstrate methods of assuring and
maintaining correct placement of PEAD’s. Demonstrate re-ventilation for missed
placement of PEAD’s.
Objectives (cont’d) Demonstrate on a manikin the proper
technique for the use and maintenance of the following airway adjuncts: Nasal cannula Non-rebreather mask Bag-Valve-Mask
Demonstrate sterile suctioning techniques on a manikin with a PEAD in place.
Lesson 1Respiratory Anatomy & Physiology
Respiratory Anatomy & Physiology
Function of the Respiratory System Removes carbon
dioxide from the blood Transfers oxygen to
the blood
The Upper AirwayEpiglottis
Mandible
Frontal Sinus
Soft Palate
Trachea
Glottis
Esophagus
Vocal Cords
A
B
C
D
E
F
G
H
The Upper Airway Other Structures
Nasopharynx Oropharynx Hypopharynx Larynx
Functions
Functions of the Upper Airway Passageway for air Warm Filter Humidify Protection
Gag Reflex Cough
Speech
The Lower AirwayPrimary Bronchi
Hyoid Bone
Right Lung
Secondary Bronchi
Tracheal Ligament
Trachea
Larynx
Esophagus
Left Lung
Trachea
A
B
C
D
E
F
G
H
I
J
Alveoli Gas Exchange
Lungs Structure Lobes Pleura
Physiology of Respiration Define Respiration
The exchange of gases between a living organism and the environment
Define Ventilation Mechanical Process that moves air in and out of
the lungs
Muscles of Breathing Intercostal Muscles Diaphragm
Regulation of RespirationWhere is the Respiratory Center Controlled? Brainstem
Medulla Apeustic Center (pons) Pneumotaxic center (pons)
Stretch receptors Hering-Breuer reflex
Chemoreceptors CSF Blood
Voluntary or Involuntary Both
Humans can override body’s urge to breathe But only for so long
Respiratory Cycle Inspiration
Active phase Lasts 1-2 seconds
Expiration Passive phase Lasts 5 seconds
Lesson 2Respiratory Volume and
Management
Drinking Straw Exercise Breathe through
straws for 1 minute
Carbon Dioxide & The Respiratory System
High CO2 Increases respiratory rate
Low CO2 Decreases respiratory rate
Hypoxic Drive Chronic COPD patients
Normal Respiratory Rates Adult Children Infants Newborns
12 – 20 / min 18 – 24 / min 22 – 36 / min 40 – 60 / min
Factors Affecting Respiratory Rate Fever Depressant Drugs Anxiety Insufficient Oxygen Stimulant Drugs Sleep
Respiratory Volumes Lung Capacity Tidal Volume Dead Space Alveolar Air
6000 mL of air 500 mL at rest 150 mL 350 mL
Minute Volume Total air moved per minute Rate X Volume = Minute volume Important Assessment Item
Factors Affecting Minute Volume Head, neck, chest injury Shock Diabetes CO2 / O2 rapid changes
Maintaining the A in ABC Patient positioning Suctioning Supplemental Oxygen Mechanical Assistance
Pulse Oximetry Measures amount of oxygen in the blood. Gives percent of hemoglobin saturated
Tool only, do not rely on totally Why?
Normal Values 95% - 100% Normal 90% - 95% - Mild – Normal for COPD < 90 % Moderate – High Flow Oxygen
End-Tidal CO2 Detection Measured
Colorimetric and Digital
Tool to aid in determining correct placement
Lesson 3
Assessing Respiratory Problems
Patient Assessment
General Patient Assessment Primary Survey
LOC ABC’s Speech Pattern Obvious Respiratory Noise Patient Position
General Assessment (cont’d)
Secondary Assessment SAMPLE history Chief Complaint Pertinent Negatives Chest Pain (pleuritic vs cardiac) Cough History Edema Vitals
Respiratory Assessment Confusion, Agitation, Orientation Cyanosis (late sign) Diaphoresis Retractions Accessory Muscle Use Jugular Venous Distention Nasal Flaring / Pursed Lip Breathing
Palpation Skin
Turgor Color Temperature Diaphoresis
Pulse Rate Rhythm Quality
Chest Wall Pain Tracheal Deviation
Assessing Lung Sounds Methods Hand Out
Lung Sounds Normal Wheezes Rales (Crackles) Stridor Rhonchi Pleural Rub
Listen on every patient End of Expiration End of Inspiration During both phases Expiration End of Inspiration
Respiratory Diseases COPD Asthma Pneumonia Pulmonary Edema Pulmonary Embolus Trauma
COPD
Chronic Obstructive Pulmonary Disease
Pink Puffers and Blue Bloaters Frequently on Home oxygen Assessment
Typical Lung Sounds
Common Medications May or May not be Hypoxic Drive
Asthma
Asthma Bronchiole Constriction & Mucous
Production Lung Sounds
Wheezes Diminished None
Usually Diagnosed
Pneumonia
Pneumonia Fever Productive Cough
Colored Sputum
General Illness Elderly & Pediatric most at risk Lung Sounds
Rhonchi, Rales, Wheezes
Pulmonary Edema
Pulmonary Edema Congestive Heart Failure
Acute – Flash Pulmonary Edema Chronic – Heart Failure
Medications Orthopnea, PND
Lung Sounds Keep them upright with legs dangling
Pulmonary Embolus
Pulmonary Embolus Lung Sounds History
Surgery Bed Confined Long trip
Rapid Transport & High Flow Oxygen
Trauma
Trauma Maintain spinal control Airway Management High Flow Oxygen Rapid Transport Seal Chest Wounds Stabilize Impaled Objects
Lesson 4Respiratory/Cardiac Arrest
Basic Airway Management
Respiratory & Cardiac Arrest
Assessing the Patient First Steps of CPR Annie, Annie You Okay? Other Signs and Symptoms
Unconsciousness Cardiac Seizure Agonal respirations or apnea Cyanosis, Ashen, Mottled No signs of spontaneous respiration or circulation No Pulse
Combitube
When to Use the Combitube CPR
Remember to do CPR! Attach AED!
Respiratory Arrest Agonal Respirations without intact gag reflex Respiratory Arrest leads to Cardiac Arrest
Airway Management – The Basics
Manual Maneuvers Chin Lift Jaw Lift Jaw Thrust Head Tilt – Chin Lift Modified Jaw thrust
Airway Management – The BasicsMechanical Airways NPA’s
OPA’s
Description Advantages Disadvantages Indications Contraindications Methods of Insertion
Airway Management – The BasicsVentilation Mouth to Mask
BVM
Description Advantages Disadvantages Indications Contraindications Methods of Use
Evaluation of Effectiveness How do I know I am ventilating?
Chest movement Lung Sounds Epigastric sounds/Abdominal distention Patient Response
Lesson 5Suctioning
Reviewing Suctioning BSI – Scene Safety Equipment
Suction device Rigid or Soft Tip
Insert with Suction Off Withdraw while
Suctioning No more than 15
seconds before ventilating!
Oh, That Sucks! Vomitus
Food Protein dissolving
enzymes Hydrochloric Acid
Aspiration damage Alveolar Damage Increased fluid Obstruction Aspiration Pneumonia
Oh, Go Spit on It Saliva
Digestive enzymes Bacteria
Aspiration Damage Fills alveoli Pneumonia
Food Clogs airways Interferes with
ventilation Pneumonia
Blood Contents
Protein Fibrin Water Electrolytes
Aspiration Damage Clog small airways Creates chemical
reaction
Suction Catheters
Rigid Advantages Disadvantages Indications Contraindications Methods of Use
Flexible Advantages Disadvantages Indications Contraindications Methods of Use
Lesson 6Dual-Lumen Airway Devices
Combitube©
Description Other Similar Devices
Pharyngeal tracheal lumen airway (PTLA) EGTA EOA
What we use Combitube©
Indications for Combitube©
Respiratory Arrest Cardiac Arrest Unconscious, without a gag reflex
Contraindications for Combitube©
Gag Reflex Conscious Breathing Adequately Caustic Ingestion Known esophageal disease or varices Under 16 y/o Under 5 feet or over 6 feet 8inches
Advantages for Combitube©
Rapid Insertion Limits regurgitation, aspiration & distention Blind insertion High oxygen delivery Less training required Inserted in neutral position
Disadvantages for Combitube©
Patient must be unresponsive without gag reflex
Some are difficult to obtain adequate seal Some do not totally protect against
aspiration Most responsive patients will vomit when
removed May damage esophagus
Demonstration
When Can I Remove the Combitube?
Patient returns to full consciousness Patient able to maintain own airway Orders from OLMC
Procedure for Removing SUCTION READY! Deflate Tube #2 Deflate Tube #1 Tell patient to exhale Pull out quickly and in-line SUCTION
Demonstration
Skills Labs Basic Airway Management
Manual Maneuvers and Simple Adjuncts Supplemental Oxygen Ventilation Suctioning
Advanced Airway Management Combitube
Questions?
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